Tinnitus | Causes, Types and Treatment Options

What is Tinnitus?

Tinnitus, otherwise known as a ringing of the ear, is a condition in which you experience sound without an external stimulus. The sound may not always be a ringing; tinnitus may appear as a hiss, whoosh, chirp, click, roar, hum, or whistle. In very rare instances, tinnitus has even appeared as music. Tinnitus may be chronic or temporary, and it may affect one or both ears. It could fluctuate in volume and frequency throughout the day.

Prevalence of Tinnitus

Tinnitus affects approximately 20% of Americans – with a 90% occurrence in cases of hearing loss. The Hearing Health Foundation reported that 60% of veterans returning from Iraq and Afghanistan have cases of tinnitus. Nationwide, approximately 16 million Americans seek medical attention for tinnitus. According to the American Tinnitus Association (ATA), "millions of Americans experience tinnitus, often to a debilitating degree, making it one of the most common health problems in this country."

Tinnitus may affect anyone, at any time. In fact, most people have had short experiences with tinnitus. If you've been exposed to loud sounds at a concert or a construction site and experienced a sort of ringing sensation in your ear afterwards, this is tinnitus. Many Americans have reported the experience of tinnitus for short bursts – as short as a minute, even. For others, chronic tinnitus is a constant companion, with sounds that are unavoidable day and night.

Tinnitus in War Veterans

In 2012, the Veterans Administration estimated that approximately 972,000 veterans returning from combat experience tinnitus. It is the leading service-related disability among US veterans. A common cause for tinnitus among veterans is exposure to loud sounds while working on or near military machinery.

The ATA has encouraged the Department of Veterans Affairs, Department of Defense, and Congress to invest in tinnitus research as a commitment to providing care for our servicemen and women. Though there are options for treating tinnitus, the condition persists. In combat zones, service men and women are encouraged to wear customized ear protection.

Effects of Tinnitus

For people with chronic tinnitus, symptoms may increase at nighttime. During the day, other sounds may mask tinnitus symptoms, but at night when it's quiet, the sounds may be more obvious.

Tinnitus has the potential to greatly affect a person's emotional and physical well-being. People with tinnitus may experience social withdrawal, stress, anxiety, depression, nervousness, anger, tension, fatigue, and irritability. Tinnitus could affect sleep patterns, memory, concentration, and productivity at school or on the job.

Hearing Loss and Tinnitus

The Hearing Health Foundation estimates that 90% of tinnitus cases occur with an underlying hearing loss. Tinnitus and hearing loss share similar causes, such as exposure to noise or presbycusis (age-related hearing loss). Damage to inner ear hair cells may cause both tinnitus and hearing loss. Researchers have suggested that when these cells are damaged, they send phantom signals to the brain to be registered as sound – which is what we recognize as tinnitus.

Types of Tinnitus

Tinnitus may be temporary (acute) or ongoing (chronic). There are two types of tinnitus: subjective and objective. Subjective tinnitus is the most common form of the condition, comprising more than 99% of all tinnitus cases. Subjective tinnitus refers to cases in which only the person who experiences tinnitus hears the sounds. Often times, subjective tinnitus indicates issues with hearing and neurological conditions related to hearing loss. Causes of subjective tinnitus include sensorineural hearing loss due to damage of inner ear hair cells (aging, exposure to loud noise, and even certain classes of ototoxic medication); Meniere's disease; impacted earwax; or other related medical conditions.

Objective tinnitus, on the other hand, is quite rare, comprising less than 1% of cases. With objective tinnitus, both the person who experiences the symptoms and people within their vicinity may hear the sounds. Objective tinnitus often points to issues with one's cardiovascular or musculo-skeletal systems. The sounds of objective tinnitus may point to issues with circulatory or somatic systems in the body. It has been referred to as pulsatile tinnitus, as sounds may be caused by increased blood flow or muscle spasms.

Causes of Tinnitus

According to the ATA, "While tinnitus is most often triggered by hearing loss, there are roughly 200 different health disorders that can generate tinnitus as a symptom." Because tinnitus often appears as a symptom of another condition, the causes are not immediately clear.

In certain cases, the cause of tinnitus may be obvious, such as impacted earwax or as a symptom of ear diseases such as Meniere's disease, which affects the level of fluid in the inner ear. If you've suffered injury to the head, neck, or throat area, this could lead to tinnitus. Tumors, infections, and hormonal changes have all been linked to tinnitus. Lifestyle habits such as smoking or taking in high doses of caffeine may also lead to tinnitus.

Tinnitus may occur as a side effect of certain ototoxic medications, which include some classes of anticancer chemotherapy medications, diuretics, and antibiotics. These drugs are considered "ototoxic" because they are poisonous to the ear and could harm your inner ear hair cells, which do not regenerate, leading to tinnitus and hearing loss.

Inner ear hair cells may also be damaged by exposure to loud noises in a single event or over a long period of time. In this case, hearing loss and tinnitus are linked. Some specialists have hypothesized that noise-induced tinnitus is caused by the malfunction of inner ear cells leaking electric signals to the brain which registers as sound, even when there is no external stimulus.

Treating Tinnitus

Because there is no singular, identifiable cause for tinnitus, there is no singular cure. With cases such as temporary tinnitus, the sounds may disappear on their own. If tinnitus is caused by impacted earwax, then removal could help alleviate tinnitus symptoms. If tinnitus is caused by certain medications, speak to your physician and let them know about the changes in your hearing.

Tinnitus often appears in cases of hearing loss. As such, leading hearing aid manufacturers have equipped their devices with tinnitus therapy options. Tinnitus therapy does not cure tinnitus, but it does offer significant relief and comfort while ensuring a comfortable and clear listening experience.

Hearing Aid Solutions for Tinnitus

Tinnitus symptoms interfere with hearing and could cause frustration and discomfort in your listening experience and daily life. Most major hearing aid manufacturers have built in a tinnitus solution in their advanced hearing aids or standalone tinnitus therapy devices. Here, we review the tinnitus solutions available with our major hearing aid brands.

Starkey Multiflex Tinnitus Technology

Starkey is an American manufacturer of hearing aids, responsible for advanced hearing aids such as the Halo 2 Made for iPhone, Z Series, and Muse Made for Life. Multiflex Tinnitus Technology is a software function that is programmed into a number of Starkey hearing aids to help wearers manage their symptoms.

Multiflex Tinnitus Technology produces a synthetic white noise, with various frequencies, that plays while you wear your Starkey hearing aid. The synthetic sound is customized to meet your specific hearing needs. We will work with you to tailor the best sound therapy treatment plan. Because your tinnitus sounds may vary in frequency and volume throughout the day, Multiflex is designed to be flexible, allowing you to adjust your tinnitus sound stimulus program to meet your needs. Starkey also offers a standalone tinnitus device, called Xino.

Widex Zen Tinnitus Therapy

Widex, a Danish manufacturer of hearing aids, is proud to offer a four-part tinnitus therapy program, a unique solution in the hearing market. ZEN Tinnitus Therapy combines technology and therapy for a holistic tinnitus solution.

Counseling, amplification, fractal (ZEN) tones, and relaxation are the four steps to comfort and better listening with ZEN Tinnitus Therapy. Counseling, with behavioral and cognitive intervention, helps alter the negative interpretation of tinnitus sounds as you experience them. At the same time, Widex hearing aids provide amplification of sounds in your life, which stimulates your ears and brain to prevent overcompensation. The third element, ZEN Tones, are relaxing synthetic sounds that simultaneously help you relax and provide stimulation. The final step, relaxation, is achieved through behavioral exercises and sleep management. ZEN Tinnitus Therapy is available as a standalone device or in select Widex hearing aids.

Signia Tinnitus Notch Therapy

Static noise tinnitus therapy signals and ocean wave tinnitus therapy signals are synthetic tones designed to mask the frustrating sounds of tinnitus. These sounds divert your attention away from the sounds of tinnitus and enable you to relax and concentrate on the sounds you want to hear. Static noise signals mix in with your tinnitus sounds and divert your attention away; there are five static noise signals available. Ocean wave sounds provide the soothing and stress-relieving sounds of lapping water, which provide relaxation and diversion from your tinnitus sounds.

Additionally, Signia hearing aids like the Primax are all crafted with built-in Notch Therapy, which has been clinically proven to reduce the annoying sounds of tinnitus (according to a 2016 study). Notch does not require any work on your part – it is built into your listening experience with any Signia hearing aid and operates any time you have your aids on. Over the long term, Notch permanently relegates tinnitus sounds to the background.

ReSound Relief

ReSound's tinnitus solution is the Relief app, which offers a combination of sound therapy and relaxation exercises. The Relief app takes into consideration the very personal nature of tinnitus, and allows you to customize your listening experience. Through the Relief app, you may choose the color and nature of sounds you want to hear, balance the sounds between your ears, and set a timer to help you sleep. The Relief app also offers a number of activities to help you cope with your tinnitus, such as deep breathing exercises, guided meditation, and games to divert your thoughts.

Phonak Tinnitus Balance Portfolio

Phonak's Tinnitus Balance Portfolio consists of three elements: Tinnitus Balance hearing aids, a broadband noise generator, and sound therapy exercises through a smartphone app. Tinnitus Balance hearing aids are designed specifically to treat tinnitus – but they are also advanced Phonak hearing aids! This means they offer the best of Phonak's listening features. The Tinnitus Balance Portfolio is available on popular Phonak models, such as Audeo and Bolero.

The Tinnitus Balance noise generator provides synthetic sounds that are fully customizable to distract you from your tinnitus sounds and help blend them with background noise. With the Tinnitus Balance app, you may customize your sounds and even use music from your own library. A timer option helps you with regulating your sleep.